05D0916425 CLIA NUMBER - PICO RIVERA COMMUNITY MEDICAL CLINIC

Laboratory Demographics

CLIA Number: 05D0916425

Facility Name: PICO RIVERA COMMUNITY MEDICAL CLINIC

Facility Address:
4705 DURFEE AVE
PICO RIVERA, CA
ZIP 90660
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Facility Phone Number: 562 692-0621

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1841232394

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name	Field Value
CLIA Number	05D0916425
LAB Type	Physician Office
Facility Name	PICO RIVERA COMMUNITY MEDICAL CLINIC
Street	4705 DURFEE AVE
City	PICO RIVERA
State	CA
ZIP	90660
Phone	562 692-0621
CertificateType	4
CertificateEffectiveDate	6/21/2022
CertificateExpirationDate	6/20/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024